CT-guided chemoablation in treating lumbar disc herniation :a randomized controlled study / 重庆医学

Objective To investigate the clinical effectiveness of chemoablation for the treatment of lumbar disc herniations (LDH) to provide reference for its clinical treatment .Methods A total of 191 cases of LDH were divided into the group A and B . All cases were performed the CT-guided chemoablation for treating LDH .The group A conducted the intra-disc injection treatment , while the group B conducted the intra-disc and extra-disc combined injection .The cases were followed up by the modes of outpatient department or telephone on postoperative 30 ,90 ,180 d .The follow up and statistical analysis were conducted by referring to the Macnab effect evaluation criteria .Results The two groups conducted the outpatient department follow up or telephone follow up on postoperative 30 ,90 ,180 d .All cases did not appear the complications such as nerve damage ,spinal cord damage and intervertebral disc infection .In the intra-group comparison ,the VAS score had statistical difference between before and after treatment ( P<0 .05) .In the inter-group comparison ,the score after treatment in the group B was lower than that in the group A (P<0 .05) .The good effect rate on postoperative 30 d in the group A was 81 .1% (77/95) ,which on postoperative 90 d was 83 .2% (79/95) and which on postoperative 180 d was 85 .3% (81/95) .The good effect rate in the group B was 85 .4% (82/96) on 30 d ,88 .5% (85/96) on 90 d and 91 .7% (88/96) on 180 d .Conclusion CT-guided lumbar intervertebral disc minimally invasive interventional chemoab-lation has good and rapid analgesic effect ,and the intra-disc and inter-disc combined treatment has better curative effect .

Reaction kinetics on renal calculus dissolution by simulating test in vitro / 实用医学杂志

Objective To investigate the reaction kinetics between the stone-dissolving solution and the urinary stone in a model simulating the condition of a kidney for further clinical administration. Methods An artificial upper urinary tract was made by silica gel. Lactic acid prepared in the preliminary study was used to react with artificial stone in the model. The concentration of reaction product in the effluent was measured to identify the reaction velocity. Relationships between the efficiency and dissolution rate or stone surface was investigated. Results The highest utilization rate of dissolution was 100 ~ 150 mL/h. Dissolution efficiency is in positive rela-tion with stone surface. The efficiency correlates with the stone surface and infusion speed in the range of 50~400 mL/h. Conclusions Before dissolution treatment ,the stone should be shattered as deeply as possible to in-crease the surface of reaction. If possible ,the irrigating speed should be as high as possible to eliminate the stone sooner.

Direct renal chemolysis with alkaline drug for infantile renal calculus resulted from melamine / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of direct renal chemolysis with alkaline drug through ureteral catheter or nephrostomy tube for the treatment of infantile renal calculus resul-ted from melamine. Methods Fifteen infants of acute post-renal failure resulted from bilateral renal calculi were treated. The age of the infants was 5--12 months(average, 9 months). Stone size varied from 0.4 to 1.5 cm (average, 0.8 cm). They were all fed on milk powder polluted with melamine for a long time and diagnosed with acute post-renal failure based on the imaging and chemical examination. Double-J stents insertion by ureteroscope was performed on 13 infants and direct renal chemolysis with alkaline drng(5% NaHCO3,20 ml)through ureteral catheter was performed during operation. Percuta-neous nephrostomy was performed on 2 infants to remove the obstruction of upper urinary tract and di-rect renal chemolysis with alkaline drug(1.4% NaHCO3, continuous perfusion by gravity) through ne-phrostomy tube was performed intermittently after operation. Results Direct renal chemolysis was performed successfully on the 15 infants. The urine volume recovered in 2--5 d, blood urea nitrogen and serum creatinine recovered in 2--3 d postoperatively. During the operation of the infants treated by direct renal chemolysis with 5%NaHCO3 throuth ureteral catheter, a large number of limous fluid spurted from ureterostoma. According to CT examination 2 weeks after operation, the stone frag-ments were removed thoroughly in 13 infants, the diameter of the stone lessened more than 50% in 2 infants. Conclusion Direct renal chemolysis with alkaline drug for eliminating infantile renal cal-culus resulted from melamine is sale and effective.

CT guided ozone injection for the ablation treatment of cervical spondylosis / 中华放射学杂志

Objective To explore the value of CT guided ozone(O_3)injection in the ablation treatment of cervical spondylosis.Methods All 86 patients with cervical spondylosis including 37 myelopathy type,30 radiculopathy type,and 16 sympathetic type were treated with O_3 injection under CT guidance.The puncture rout was from the anteroparaline of neck to the disk.A total of (4?3)ml of O_3 with concentration 60?g/ml was injected into the disk and 10 ml of O_3 with concentration 40?g/ml was injected to the paraspinal tissue.Results After injection CT scan showed that O_3 was distributed within the disk and the protruding part as low-density air shadow in 37 myelopathy type and 30 radieulopathy type patients.O_3 was observed to spread in the anterior epidural space of spinal canal and the paraspinal tissue.Three months after 03 injection,67 patients (78% )showed excellent clinical efficacy,14 (16% )had good clinical efficacy,and 5 (6%)were poor respectively.Conclusion CT guided O_3 injection is an accurate,safe, and effective method in the treatment of cervical spondylosis.

Study on CT-guided collagenase injection in the treatment of herniation of L4-5 lumbar disc by posterolateral approach / 介入放射学杂志

Objective CT-guided collagenase injection through posterolateral path into the interior and superficial prominence of the herniated lumbar disc in the treatment of L4-5 lumbar disk herniation.Methods The approach of posterolateral path to the prominence through intervertebral foramen and epidural space of L4-5 was established according to the analysis of anatomical features and vertebral medical images. The accuracy and safety of the approach were evaluated by CT scanning after epidural injection with air. CT-guided injection was operated in 66 cases of prolapse of L4-5 intervertebral disc confirmed by CT. Results Technical success was 100%. Followed up for 3 months to 3 years, 62 cases (93%) were markedly suecessfud with the effective rate of 93%. Twenty-three had CT re-examination three months later showed the prominences becoming smaller or disappeared in 22 patients having a resolved rate of 95%.Conclusions CT-guided injection of collagenase is one of the effective methods for the treatment of prolapse of L4-5 intervertebral disc.

Technical and clinical study on CT-guided collagenase injection in the treatment of herniated lumbar disc / 中华放射学杂志

Objective To investigate the technique and effectiveness of CT-guided collagenase injection into prominence of herniated lumbar disc and the surface of prominence in the treatment of lumbar disc herniation. Methods One hundred and fifty-five patients with lumbar disc herniation diagnosed by clinic and CT received CT-guided collagenase injection, with the approaches via intervertebral foramen in L3-4 and L4-5, and the approaches via margo medialis of joint processus articularis in L5-S1. Results Injection was done successfully in all patients (100%), the clinical rate of excellent and good results were 94.2%. The herniation disappeared or significantly reduced as demonstrated by CT scan in 32 of 34 patients (94.1%), the rate of excellent and good results were 100%. No changes existed in 2 cases. There were 2 cases of disc inflammation in our group. Conclusions CT-guided collagenase injection into the prominence of herniated lumbar disc and its surface is a safe and efficient method in the treatment of herniated lumbar disc.

Medical Treatment for Uric Acid Calculi / 대한비뇨기과학회지

While surgical intervention may occasionally be indicated for the relief of pain or urinary obstruction, many uric acid stones can be treated medically. We have analysed 27 patients with uric acid stone treated at Soonchunhyang University Hospital from January 1991 to September 1994. Major clinical complaints were presented with flank pain(93%) and gross hematuria(33%). On the urinalysis, urinary pH was 5.0 in 21 patients(78%) , 5.5 in 4 patients(15%), and 6.0 in 2 patients(7%). The urate crystals were found in 11/27 patients(41%). Mean serum uric acid level was 6.5+/-3.2mg% and mean uric acid amount of 24hrs urine was 301+/-188mg. Intravenous urography, retrograde urography, antegrade urography, ultrasonography and computed tomography were used for the diagnosis of uric acid stone. Systemic medical therapy was performed in all patients using hydration, sodium bicarbonate, and allopurinol. Systemic medical therapy and local chemolysis with alkaline irrigating solution were performed in 6 patients(22%) when the stone size was large (.>2cm) or urinary obstruction existed. The uric acid stone, in whom treated with only systemic medical therapy(21), were to be dissolved and passed during 1-24weeks, whereas the other patients(6) with systemic medical therapy and local chemolysis due to complete obstruction or large stone( >=2cm) had taken 2-32weeks. Successful dissolution was obtained in all patients, however, most significant problem of uric acid stone chemolysis is that it takes a long time. Nevertheless, these results demonstrate that the medical treatment could ordinally be considered to the treatment of choice for removal of uric acid calculi before surgical intervention or extracorporeal shock wave lithotripsy.

Experimental study of chemolysis with collagenase outside the intervertebral disk / 中华麻醉学杂志

ve To assess the efficacy of chemolysis with collagenase injected into epidural space and the effects upon intervertebral disk and nerve roots. Methods Sixty-four healthy new Zealand rabbits of either sex, weighing 2.5-3.0kg were divided into four groups of sixteen each: group A, B, C and D. In group A and B herniation of disk was produced by injecting normal salin 0.1ml into the intervertebral disk after surgical resection of spine and posterior arch of L4_6, while in group C and D no herniation of disk was produced. In group A and C collagenase 300u( in normal saline 0.5ml) was injected into the epidural space at the level of L4-6, and in group B and D normal saline 0.5ml was injected into epidural space as control. Three animals from each group were sacrificed on the 7th, 15th, and 30th day after operation and intervertebral disk and nerve roots at the operation site were removed and fixed for light and electron microscopic examination. Sciatic nerve conduction velocity (NCV) was measured before operation and on 1st, 7th, 15th and 30th postoperative day. Results In group A the intervertebral disk was dissolved to some extent. In group B nerve roots were injured to different degree. In group A and C NCV was higher than normal on the 7th and 15th day after operation. Conclusions Collagenase may dissolve the herniated intervertebral disk but does not injure the nerve roots. It may increase NCV.

Treatment of lumbar disk herniation with MRI guidance injection of oxygen-ozone / 中华放射学杂志

Objective To evaluate the applied value of percutaneous oxygen-ozone injection in the treatment of lumbar disc herniation under open 0.23 T MRI guidance.Methods Mounted with ipath 200 optical tracking system,MR-guided injection of oxygen-ozone were performed via a medial border of the articular processes approach in 73 patients with clinically diagnosed LDH.MR compatible 19.5G or 21.0 G biopsy needle was used. Discography was performed in order to select indication before injection oxygen- ozone into nucleus pulposus in 26 patients.Sixty-four patients were injected to three sites:(1)Six to 10 ml oxygen-ozone was injected into discs centers,injected and suctioned alternately in order to make nucleus pulposus oxidation thoroughly.(2)The needle was withdrawn according to the scale of biopsy needle and optical tracking.Then,10 ml oxygen-ozone was injected into disc herniation. (3)After that,needle was withdrawn further about 1.0—1.5 cm to outside of annulus fibrosus.Fifteen to 20 ml oxygen-ozone was injected into intervertebral foramina around nerve roots.The oxygen-ozone concentration was 35—45?g/ml. Nine patients were only performed injection of oxygen-ozone into around nerve root,while not injection oxygen-ozone to nucleus pulposus for considering bad curative effect after discography.Results All of 73 patients were successfully local targeted and treated under MRI guidance without serious complications, such as nerve root injury.After 3—6 months follow-up,total overall efficacy was 91.3% with the excellent in 28,good in 39,and poor in 6,respectively.Conclusion Open MR-guided injection of oxygen-ozone, mounted with optical tracking system,is a safe and effective minimally invasive therapy for treating LDH.